Requirements for Day Treatment Intensive and Day Rehabilitation Sample Clauses
The 'Requirements for Day Treatment Intensive and Day Rehabilitation' clause defines the standards and conditions that must be met for the provision of intensive day treatment and rehabilitation services. It typically outlines criteria such as staffing qualifications, program structure, patient eligibility, and documentation protocols that providers must follow to deliver these services. For example, it may require a certain staff-to-patient ratio or specify the types of therapeutic activities offered during treatment hours. The core function of this clause is to ensure that day treatment and rehabilitation programs maintain a consistent quality of care and comply with regulatory or contractual expectations, thereby protecting patient welfare and program integrity.
Requirements for Day Treatment Intensive and Day Rehabilitation. A. The Contractor shall require providers to request payment authorization for day treatment intensive and day rehabilitation services:
1) In advance of service delivery when day treatment intensive or day rehabilitation will be provided for more than five days per week.
2) At least every three months for continuation of day treatment intensive.
3) At least every six months for continuation of day rehabilitation.
4) Contractor shall also require providers to request authorization for mental health services, as defined in California Code of Regulations, title 9, section 1810.227, provided concurrently with day treatment intensive or day rehabilitation, excluding services to treat emergency and urgent conditions as defined in California Code of Regulations, title 9, sections 1810.216 and 1810.253. These services shall be authorized with the same frequency as the concurrent day treatment intensive or day rehabilitation services.
B. The Contractor shall not delegate the payment authorization function to providers. When the Contractor is the day treatment intensive or day rehabilitation provider, the Contractor shall assure that the payment authorization function does not include staff involved in the provision of day treatment intensive, day rehabilitation services, or mental health services provided concurrent to day treatment intensive or day rehabilitation services.
C. The Contractor shall require that providers of day treatment intensive and day rehabilitation meet the requirements of California Code of Regulations, title 9, sections 1840.318, 1840.328, 1840.330, 1840.350 and 1840.352.
D. The Contractor shall require that providers include, at a minimum, the following day treatment intensive and day rehabilitation service components:
Requirements for Day Treatment Intensive and Day Rehabilitation. 1. Authorization and Service Requirements The Contractor shall require providers to request an initial mental health plan (MHP) payment authorization, as defined in Title 9, CCR, Section 1810.229, from the Contractor for day treatment intensive and for day rehabilitation. Provider as used in this section includes Contractor staff. The Contractor shall require providers to request MHP payment authorization from the Contractor in advance of service delivery when day treatment intensive or day rehabilitation will be provided for more than five days per week. The Contractor shall require providers to request MHP payment authorization from the Contractor for continuation of day treatment intensive at lease every three months and day rehabilitation at least every six months. The Contractor’s MHP payment authorization function shall meet the criteria of Exhibit A, Attachment 2, Section B, except that the Contractor shall not delegate the MHP payment authorization function to providers. In the event that the Contractor is the day treatment intensive or day rehabilitation provider, the Contractor shall assure that the MHP payment authorization function does not include Contractor staff involved in providing day treatment intensive or day rehabilitation. The Contractor shall require providers to request initial MHP payment authorization from the Contractor for counseling, psychotherapy or other similar therapeutic interventions that meet the definition of mental health services as defined in Title 9, CCR, Section 1810.227, excluding services to treat emergency and urgent conditions as defined in Title 9, CCR, Sections 1810.216 and 1810.253 and excluding therapeutic behavioral services as described in DMH Letter No. 99- 03, that will be provided on the same day that day treatment intensive or day rehabilitation is being provided to the beneficiary. The Contractor shall require the providers of these services to request MHP payment authorization from the Contractor for continuation of these on the same cycle required for continuation of the concurrent day treatment intensive or day rehabilitation for the beneficiary. The Contractor shall not delegate the MHP payment authorization function to the provider of day treatment intensive or day rehabilitation or the provider of the additional services.
2. In addition to meeting the requirements of Title 9, CCR, Sections 1840.318, 1840.328, 1840.330, 1840.350, and 1840.352, the Contractor shall require that providers of day t...
Requirements for Day Treatment Intensive and Day Rehabilitation. A. The Contractor shall require providers to request payment authorization for day treatment intensive and day rehabilitation services:
1) In advance of service delivery when day treatment intensive or day rehabilitation will be provided for more than five days per week.
2) At least every three months for continuation of day treatment intensive.
3) At least every six months for continuation of day rehabilitation.
4) Contractor shall also require providers to request authorization for mental health services, as defined in Cal. Code Regs., tit. 9, § 1810.227, provided concurrently with day treatment intensive or day rehabilitation, excluding services to treat emergency and urgent conditions as defined in Cal. Code Regs., tit. 9, §1810.216 and § 1810.253. These services shall be authorized with the same frequency as the concurrent day treatment intensive or day rehabilitation services.
B. The Contractor shall not delegate the payment authorization function to providers. When the Contractor is the day treatment intensive or day rehabilitation provider, the Contractor shall assure that the payment authorization function does not include staff involved in the provision of day treatment intensive, day rehabilitation services, or mental health services provided concurrent to day treatment intensive or day rehabilitation services.
C. The Contractor shall require that providers of day treatment intensive and day rehabilitation meet the requirements of Cal. Code Regs., tit. 9, §§ 1840.318, 1840.328, 1840.330, 1840.350 and 1840.352.
D. The Contractor shall require that providers include, at a minimum, the following day treatment intensive and day rehabilitation service components:
Requirements for Day Treatment Intensive and Day Rehabilitation. A. The Contractor shall require providers to request prior authorization for day treatment intensive and day rehabilitation services, in accordance with Information Notice 22-016 and any subsequent departmental notices.
B. The Contractor shall require that providers of day treatment intensive and day rehabilitation meet the requirements of Cal. Code Regs., tit. 9, §§ 1840.318, 1840.328, 1840.330, 1840.350 and 1840.352.
C. The Contractor shall require that providers include, at a minimum, the following day treatment intensive and day rehabilitation service components:
Requirements for Day Treatment Intensive and Day Rehabilitation. A. The Contractor shall require providers to request payment prior authorization for day treatment intensive and day rehabilitation services, in accordance with Information Notice 19-026 and any subsequent departmental notices.
1) In advance of service delivery when day treatment intensive or day rehabilitation will be provided for more than five days per week.
2) At least every three months for continuation of day treatment intensive.
3) At least every six months for continuation of day rehabilitation.
4) Contractor shall also require providers to request authorization for mental health services, as defined in California Code of Regulations, title 9, section 1810.227, provided concurrently with day treatment intensive or day rehabilitation, excluding services to treat emergency and urgent conditions as defined in California Code of Regulations, title 9, sections 1810.216 and 1810.253. These services shall be authorized with the same frequency as the concurrent day treatment intensive or day rehabilitation services.
B. The Contractor shall not delegate the payment authorization function to providers. When the Contractor is the day treatment intensive or day rehabilitation provider, the Contractor shall assure that the payment authorization function does not include staff involved in the provision of day treatment intensive, day rehabilitation services, or mental health services provided concurrent to day treatment intensive or day rehabilitation services.
Requirements for Day Treatment Intensive and Day Rehabilitation. The Contractor shall require providers to request payment authorization for day treatment intensive and day rehabilitation services:
Requirements for Day Treatment Intensive and Day Rehabilitation. A. The Contractor shall require contracted providers to request prior authorization for day treatment intensive and day rehabilitation services, in accordance with BHIN 22-016 and any subsequent departmental notices.
B. The Contractor shall require that contracted providers of day treatment intensive and day rehabilitation meet the applicable requirements of 9 C.C.R. §§ 1840.318, 1840.328, 1840.330, 1840.350 and 1840.352.
C. The Contractor shall require that contracted providers of day treatment intensive and day rehabilitation programs include in the services provided one or more of the following service components: assessment, treatment planning, therapy, psychosocial rehabilitation. Both programs must have a clearly established site for services although all services need not be delivered at that site and some service components may be delivered through telehealth or telephone.
D. Staffing Requirements. Staffing ratios shall be consistent with the requirements in 9 C.C.R. § 1840.350, for day treatment intensive, and 9 C.C.R. tit. 9 § 1840.352 for day rehabilitation. For day treatment intensive, staff shall include at least one staff person whose scope of practice includes psychotherapy.
1) Program staff may be required to spend time on day treatment intensive and day rehabilitation activities outside the hours of operation and therapeutic program (e.g., time for travel, documentation, and caregiver contacts).
2) The Contractor shall require that at least one staff person be present and available to the group in the therapeutic milieu for all scheduled hours of operation.
3) The Contractor shall require day treatment intensive and day rehabilitation programs to maintain documentation that enables the Contractor and the Department to audit the program if it uses day treatment intensive or day rehabilitation staff who are also staff with other responsibilities (e.g., as staff of a group home, a school, or another mental health treatment program). The Contractor shall require that there is documentation of the scope of responsibilities for these staff and the specific times in which day treatment intensive or day rehabilitation activities are being performed exclusive of other activities.
E. The Contractor shall ensure that the contracted provider receives Medi- Cal reimbursement only if the member is present for at least 50 percent of scheduled hours of operation for that day. In cases where absences are frequent, it is the responsibility of the Contractor...